Autism Insurance Mandate: Why SB 57 Passed in 2014

Autism in Utah is hitting record numbers. The national average for children with Autism is 1 in every 88. For Utah this number changes drastically to 1 in every 47. To battle this increasing regularity of children with Autism, Utah Senate Bill 57 was proposed to help provide insurance coverage for Autistic Children.

Proponents of SB 57 (autism insurance reform bill) believe that state-regulated health plans must be available to families dealing with Autism to cover speech, occupational and physical therapy, psychological and psychiatric care, and behavioral health treatments, including applied behavior analysis (ABA).

Behavioral health treatment benefits would be capped annually at $36,000 through age 9 and $18,000 from ages 9 through 18.

Many believe that Autism is a treatable disorder however most children in Utah do not have access to treatment. A staggering 80% to 90% of maladaptive behaviors are eliminated through evidence-based treatment. 47% of the children that do receive evidence-based treatment do not require ongoing special education versus only 2% of those who do not receive treatment.

The average state savings for a child with autism who receives evidence-based treatment is between $900,000 and $1,500,000.

A recent claim has sparked a debate as to what role the insurance company should play with the issue of Autism. An Autistic child was climbing a tree and fell to the ground and broke his arm.

When the child’s parents submitted the claim to their insurance company, they were told it was not covered because the fall was the result of their child being autistic. This story is one of many and is one of the reasons why proponents were pushing for this reform bill.

Sen. Brian Shiozawa said it best during a senate floor debate on this issue: “we faithfully pay our premiums, please cover our condition.”

With Autism numbers rising and reaching “epidemic” proportions in the state of Utah, many believe action must be taken now to help curb this rising number and provide the means for those who need treatment to receive it.